People with mental illness are overrepresented throughout the criminal justice system. In Italy, the Judicial Psychiatric Hospitals are now on the edge of their closure in favor of small-scale therapeutic facilities (REMS). Therefore, when patients end their duty for criminal behaviors, their clinical management moves back to the outpatient psychiatric centers. Elevated risks of rule-violating behavior are not equally shared across the spectrum of psychiatric disorders. To broaden the research in this area, we analyzed sociodemographic, clinical, and forensic variables of a group of psychiatric patients with a history of criminal behaviors, attending an outpatient psychiatric service in Milan, focusing on substance use disorder (SUD).

This is a cross-sectional single center study, conducted from 2020. Seventy-six subjects with a history of criminal behaviors aged 18 years or older and attending an outpatient psychiatric service were included. Demographic and clinical variables collected during clinical interviews with patients were retrospectively retrieved from patients’ medical records. Appropriate statistical analyses for categorical and continuous variables were conducted.

Data were available for 76 patients, 51.3% of them had lifetime SUD. Lifetime SUD was significantly more common in patients with long-acting injectable antipsychotics therapy, a history of more than 3 psychiatric hospitalizations, and a history of previous crimes, particularly economic crimes. Additionally, this last potential correlation was confirmed by logistic regression.

Data emerging from this survey provide new information about offenders with lifetime SUD attending an Italian mental health service. Our preliminary results should be confirmed in larger sample sizes.

The aim of this study is to examine the utilization of psychiatric services for inpatients with psychosis over a period of five years after first admission, and to identify factors that contribute to intensive service use in terms of cumulative length of in-patient treatment and readmission rate.

A cohort of 424 patients with psychotic disorders (out of a sample of 2565 first-admitted patients from a catchment area in Switzerland) was examined by means of register data.

Patients admitted for psychosis spent the longest time in hospital compared to other diagnoses, but there was considerable within-sample variation, and most patients (60.4%) had only one in-patient episode. Of the total time accumulated in this sample, 50.5% was ‘consumed’ by 10.7% of patients. Regarding the overlap between ‘heavy use’ and ‘frequent use’ (those 10% of the sample with the longest/ most frequent hospitalizations), only 39.5% of the ‘frequent users’ were also ‘heavy users’ (vice versa: 38.6%). ‘Clinical’ measures were the main predictors of the overall time spent as an in-patient (schizophrenia diagnosis, therapeutic measures, clinical improvement). Concerning ‘heavy use’, homelessness was yet another important risk factor. Sociodemographic variables (age, level of education, living alone) particularly influenced the number of hospitalizations. A younger age at first admission was predictive of ‘heavy’ and ‘frequent’ use.

Clinical and sociodemographic factors explain differences in in-patient service consumption among patients with psychosis. Efforts to devise effective interventions have to take both into account, but different measures are needed to address ‘heavy’ and ‘frequent’ use.

The use of coercive measures in psychiatry is still poorly understood. Most empirical research has been limited to compulsory admission and to risk factors on an individual patient level. This study addresses three coercive measures and the role of predictive factors at both patient and institutional levels.

Using the central psychiatric register that covers all psychiatric hospitals in Canton Zurich (1.3 million people), Switzerland, we traced all inpatients in 2007 aged 18–70 (n = 9698). We used GEE models to analyse variation in rates between psychiatric hospitals.

Overall, we found quotas of 24.8% involuntary admissions, 6.4% seclusion/restraint and 4.2% coerced medication. Results suggest that the kind and severity of mental illness are the most important risk factors for being subjected to any form of coercion. Variation across the six psychiatric hospitals was high, even after accounting for risk factors on the patient level suggesting that centre effects are an important source of variability. However, effects of the hospital characteristics ‘size of the hospital’, ‘length of inpatient stay’, and ‘work load of the nursing staff’ were only weak (‘bed occupancy rate’ was not statistically significant).

The significant variation in use of coercive measures across psychiatric hospitals needs further study.